Subjective versus objective assessment of breast reconstruction

Helga Henseler*, Joanna Smith, Adrian Bowman, Balvinder S. Khambay, Xiangyang Ju, Ashraf Ayoub, Arup K. Ray

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)


Background: To date breast assessment has been conducted mainly subjectively. However lately validated objective three-dimensional (3D) imaging was developed. The study aimed to assess breast reconstruction subjectively and objectively and conduct a comparison. Methods: In forty-four patients after immediate unilateral breast reconstruction with solely the extended latissimus dorsi flap the breast was captured by validated 3D imaging method and standardized 2D photography. Breast symmetry was subjectively evaluated by six experts who applied the Harris score giving a mark of 1-4 for a poor to excellent result. An error study was conducted by examination of the intra and inter-observer agreement and agreement on controls. By Procrustes analysis an objective asymmetry score was obtained and compared to the subjective assessment. Results: The subjective assessment showed that the inter-observer agreement was good or substantial (p-value: <0.0001). There was moderate agreement on the controls (p-value: <0.0001) and fair (p-values: 0.159, 0.134, 0.099) to substantial (p-value: 0.005) intra-observer agreement. The objective assessment revealed that the reconstructed breast showed a significantly smaller volume compared to the opposite side and that the average asymmetry score was 0.052, ranging from 0.019 to 0.136. When comparing the subjective and objective method the relationship between the two scores was highly significant. Conclusion: Subjective breast assessment lacked accuracy and reproducibility. This was the first error study of subjective breast assessment versus an objective validated 3D imaging method based on true 3D parameters. The substantial agreement between established subjective breast assessment and new validated objective method supported the value of the later and we expect its future role to expand.

Original languageEnglish
Pages (from-to)634-639
Number of pages6
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Issue number5
Early online date8 Feb 2013
Publication statusPublished - 31 May 2013


  • 3D imaging
  • breast reconstruction
  • error study
  • multiple stereophotogrammetry
  • objective assessment
  • subjective assessment


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